Health coverage options for employers and employee
The first step to considering whether to offer health coverage to your employees is to understand the health coverage options available in Oregon:
- Employer-sponsored group coverage
- Small employers with 50 or fewer employees may be eligible for small group coverage.
- If you have fewer than 25 FTE (full-time equivalent), you may be eligible for the Small Business Health Care Tax Credit (see below).
- Large employers with more than 50 FTE must offer employer-sponsored health coverage to their employees that meets the employer shared responsibility provisions.
- Individual health coverage
- Oregon Health Plan
- Individuals and families who work part time may qualify for Oregon's Medicaid program, also called Oregon Health Plan, which is free coverage for low-income Oregonians.
- Private health insurance
- People who are not offered employer-sponsored health coverage, Oregon Health Plan, or Medicare can purchase health coverage through a health insurance company or through the Marketplace.
- Financial help is available through the Marketplace to reduce the monthly premium and out-of-pocket costs.
- American Indians and Alaskan Natives may qualify for additional savings and protections through the Marketplace.
- Federal health coverage program through Social Security for people who are 65 or older, are on Social Security Disability for 24 months, or have end-stage renal disease (ESRD).
- Association health plans
- Allow many small- to medium-sized companies the ability to come together under one health plan, potentially reducing costs and increasing benefit options.
- There are regulations around these entities and criteria to participate, but coverage is not regulated or guaranteed for essential health benefits or pre-existing conditions.
- Health reimbursement arrangements
- HRAs allow employers to contribute pre-tax funds to help employees pay for medical expenses.
Small-group coverage is available year round, unlike individual health insurance, which has a set enrollment window.
If you have at least one employee who receives a W2, you can purchase coverage for yourself and your workers at any time. Small businesses with one to 50 employees can purchase a plan from any insurer offering a small-group plan in Oregon.
**Employees who are offered employer-sponsored coverage likely are not eligible for financial assistance through HealthCare.gov.
If you are not currently offering health insurance, but want to get an estimate of what offering coverage through a Marketplace certified plan may cost, use our
premium calculator. You can then use that information to use the tax credit estimator.
If you need help getting more information about these plans or other available options, please contact a licensed agent. You can find a local agent through
the Marketplace website.
Eligible small-group medical and dental plans: 2023 | 2022 | 2021 | 2020
Coverage for family members
Can your organization sponsor health coverage for additional family members? If not, the family may get a better deal through HealthCare.gov (possibly getting financial assistance) or if they are eligible for the Oregon Health Plan, rather than being offered full-cost coverage through a family member's employer. Being offered full-cost coverage through an employer would make the family members ineligible for any financial help through the Marketplace.
Don't have employees?
An individual can apply for financial help and enroll in individual coverage through HealthCare.gov:
- During open enrollment, Nov. 1 to Dec. 15.
- Year round through the Oregon Health Plan.
- During a special enrollment period. This is a 60-day period that can be triggered by certain life events, such as getting married, having a baby, or losing other health insurance coverage.
Health Care Tax Credit
Small businesses with fewer than 25 full-time employees may be eligible for the Small Business Health Care Tax Credit if they choose one of the
small-group plans certified by the Oregon Health Insurance Marketplace. If your business qualifies, the tax credit may cover up to 50 percent of the employer paid premiums.
Tax-exempt nonprofits also qualify for a tax credit up to 35 percent of premiums paid. For nonprofits, the credit is actually a refund on quarterly payments made to the IRS for income tax withholdings or Medicare withholdings from employee wages.
How will the credit make a difference for you?
The maximum credit is:
- 50 percent of premiums paid for small-business employers
- 35 percent of premiums paid for small tax-exempt employers
- The credit is available to eligible employers for two consecutive taxable years
The amount of the credit you receive works on a sliding scale. The smaller the number of employees, the bigger the credit. The same goes for wages: a smaller average salary base, the bigger the credit.
For example, an employer with five employees and a payroll of $200,000 with annual insurance costs of $40,000 would receive a tax credit of more than $9,000 per year. Factor in the second year of eligibility, and this employer would save more than $18,000 in two years.
What are the qualifications for the tax credit?
Your business or nonprofit must meet the following minimum criteria to qualify:
- Employ fewer than 25 full-time equivalent employees (not including family members or owners/partners or seasonal workers who work fewer than 120 days during the taxable year)
- Pay average annual salaries of $50,000 or less per employee
- Pay at least 50 percent of full-time employees' premium costs
- Purchase a certified medical or dental plan:
How do I claim the tax credit?
- Purchase a certified medical or dental plan directly from a participating insurance carrier.
- Inform your insurance carrier that you want to apply for the tax credit – your agent can do this for you. Your insurance carrier will then contact the Oregon Health Insurance Marketplace to request a letter confirming that the plan you purchased is certified.
- Receive a confirmation letter from the Oregon Health Insurance Marketplace.*
File the confirmation letter with your taxes when applying for the small business tax credit.
- The Marketplace will send the letter to you, your agent, and your insurance carrier.
* Note: The Oregon Health Insurance Marketplace does not determine eligibility for the IRS Small Business Health Care Tax Credit; we only confirm that the plan purchased is certified.
Resources for employers
If you have questions, please contact the Marketplace at 855-268-3767 (toll-free) or firstname.lastname@example.org.